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The present case is unique because it describes transcatheter mitral valve replacement with a valve-in-valve procedure in an emergent setting of pulmonary edema and cardiogenic shock. Although transcatheter mitral valve replacement is in its initial phase, it remains a viable option in an emergency. Further research is needed to evaluate the short term and long-term outcomes. (Level of Difficulty: Beginner.), Graphical abstract, The present case is unique because it describes transcatheter mitral valve replacement with a valve-in-valve procedure in an emergent setting…

Thyrotoxic periodic paralysis (TPP) is a potentially fatal complication of hyperthyroidism, characterized by recurrent muscle paralysis and hypokalemia. We present a case of a 32-year-old apparently healthy male patient, who presented with acute paraparesis associated with hypokalemia (K: 1.6 mmol/L), complicated by ventricular tachycardia (VT). Advanced cardiac life support was initiated with an amiodarone infusion, and eventually QRS complex narrowed and wide complex tachycardia resolved. Intravenous potassium chloride (KCl) 40 mEq over 2-3 h and oral KCL 40 mEq were administered to treat the electrolyte imbalance. Patient paralysis was quickly reversed; motor function was regained with movement of the lower extremities. This case highlights the importance of early recognition and prompt treatment of TPP as a differential diagnosis for muscle weakness, especially in the setting of severe hypokalemia. It is important to pay attention to the possibility of the development of lethal VT associated with hypokalemia in the setting of hyperthyroidism and thyrotoxic paralysis.

Mantle cell lymphoma (MCL), a type of B-cell non-Hodgkin’s lymphoma, is a rare and aggressive disease with a poor prognosis due to its advanced presentation at diagnosis. It is characterized by a translocation in the Bcl-1 gene, which results in overexpression of cyclin D1. MCL is frequently seen in the form of multiple lymphomatous polyposis (MLP) in which innumerable polyps are observed in the gastrointestinal (GI) tract. In rare instances, MCL presents a single mass. The most common presentation involves male patients in their sixties, with generalized lymphadenopathy, extranodal involvement, and B symptoms (night sweats, fever, and weight loss). Endoscopic findings of MLP include cerebroid folding of the gastric mucosa and innumerable polyps extending from the duodenum to the large intestine and are reported in approximately 9% of all GI lymphomas. Less commonly, only 2–4% of GI malignancies present as a primary GI MCL as a single mass, usually in the stomach and ileocecal region in the intestine. Radiologic findings include lymphadenopathy, splenomegaly, multiple polyposis, or wall thickening with ulceration or mass formation. In most instances, advanced disease is found at diagnosis, for which 5-year survival ranges only from 26 to 46%, even when appropriate treatment is initiated. High mitotic rate, or Ki-67 index, is of prognostic value and is associated with poor prognosis. Treatment involves conventional chemo-immunotherapy consisting of R CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or RB (rituximab and bendamustine), with the latter being better tolerated and associated with longer progression-free survival. Surgical resection is usually limited to patients in which complications are seen such as bleeding, perforation, or bowel obstruction. We present a unique case of a 70-year-old male with nonbilious, nonbloody emesis, and symptomatic anemia who was found to have a cecal mass consistent with MCL.

Mechanical support represents an evolving field of clinical research and practice. Impella is load and not rhythm dependent and it showed improvement in shock outcome compared with IABP A 72 YO F. with HTN, A-fib not on AC who presented with aphasia & Rt hemiparesis. A CT of the head showed MCA

Central hypoventilation syndrome (CHS) is rare disorder of autonomic dysregulation that causes respiratory failure and bradyarrythmia and severe metabolic disturbances. Lack of counterregulatory responses create a deadly combination of fatal derangements in asymptomatic patients. CHS is typically a

Surgical AVR is the best Rx of severe AS by guidelines. Mechanical valves demand lifelong anticoagulation due to the high thrombogenicity. According to the ACC, the target INR is 2.5 if no additional risk factors are present. A 60 YO M. with a PMH of mechanical AVR who presented with severe